INDICATIONS FOR SURGICAL TREATMENT IN LUMBAR DISC HERNIA

Cauda equina syndrome (’emergency surgery’ indication): May be due to compression of massive ruptured disc, usually midline, very often L4-5, often overlapping with a pre-existing condition (spinal stenosis).
Progressive or acute significant loss of strength (’emergency surgery’ indication): Acute development or progression of motor weakness is considered an indication for rapid surgical decompression.
Inadequacy in medical treatment:
Significant persistence of symptoms 4-6 weeks after 2 weeks of bed rest and appropriate medical treatment or persistence of symptoms after 3 months.
Continuation or increase of severe sciatic pain despite 2-3 weeks of bed rest.
Patients in antalgic posture whose very severe sciatic pain persists intolerably despite adequate bed rest and narcotic pain medication.
Frequent recurrent episodes of disc herniation: Recurrent incapacitating episodes of sciatic pain.
Sensory and reflex changes aid diagnosis. However, there is no indication for surgical intervention.